AI Article Synopsis
- The study looked at how well doctors and nurses followed a set of rules for treating patients with delirium in an ICU five years after a program to teach them those rules ended.
- They checked the medical records of 236 patients from late 2019 to early 2020 and found some areas had gotten better, like how often patients got physical therapy, while one area, related to light sedation, had gotten worse.
- Overall, they noticed that while some things improved, the length of time patients stayed in the ICU got longer, and more patients experienced delirium compared to five years earlier.
Article Abstract
Objective: To explore the level of sustained adherence to a delirium guideline in a university intensive care unit setting five years after cessation of a multifaceted implementation program conducted between April 2012 and February 2015.
Research Methodology/design: A quantitative retrospective cohort study was conducted using the medical records of all eligible patients admitted to the intensive care unit from November 2019 to February 2020.
Setting: Four adult intensive care units in a university hospital.
Main Outcome Measures: Primary outcome is adherence to seven performance indicators indicated in the guideline being: light sedation days, mobilisation, physical therapy, analgesics use, delirium and sedation screening and avoiding benzodiazepines. Clinical patient outcomes such as Intensive care unit stay and prevalence of delirium were also collected. Data were compared with the results of the original implementation study's using descriptive statistics and Kruskal-wallis and Chi-square tests.
Results: Data of 236 patients were included. The most notable decrease in adherence concerned 'number of light sedation days' (-28 %). Adherence to three indicators had increased: 'number of days receiving out-of-bed mobilisation' (+11 %); 'number of days receiving physical therapy' (+9%); and 'use of analgesics' (+12 %). Comparison of clinical outcomes showed an increased intensive care unit length-of-stay from 3 to 5 days (P < 0.001). Prevalence of delirium increased over five years from 41 % to 43 % of patients while delirium duration decreased from a median of 3 days to a median of 2 days.
Conclusion: Five years after ceasing of implementation efforts regarding the delirium guideline, partial sustainability has been achieved. The decrease in adherence to 'number of light sedation days' could have contributed to the increased length-of-stay on the intensive care unit.
Implications For Clinical Practice: After implementation, routine monitoring of performance indicators is required to evaluate the level of sustainment. Further, revisiting reasons for decrease in guideline adherence when contextual changes occur. Reassessment of the perceived barriers and facilitators can guide adaptations to sustain, or even improve, adherence.
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| http://dx.doi.org/10.1016/j.iccn.2023.103398 | DOI Listing |
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